<!DOCTYPE html>
<html xmlns:th="http://www.thymeleaf.org">

<head>
    <meta name="viewport" content="width=device-width, initial-scale=1, maximum-scale=1">
    <meta http-equiv="pragma" content="no-cache"/>
    <meta http-equiv="Cache-Control" content="no-cache"/>
    <meta http-equiv="Cache-Control" content="no-store"/>
    <meta http-equiv="Expires" content="0"/>
    <link rel="shortcut icon" type="image/x-icon" th:href="@{/static/favicon2.ico}">
    <link rel="stylesheet" th:href="@{/static/plugins/layui/css/layui.css}">
    <link rel="stylesheet" th:href="@{/static/css/layout.css}">
    <link rel="stylesheet" th:href="@{/static/css/common.css}">

</head>
<body>
<!--主体内容区-->
<div class="form-content">
    <form class="layui-form">
        <div class="layui-form-item">
        </div>
        <div class="layui-form-item">
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label ">姓名</label>
            <div class="layui-input-block">
                <input type="text" name="elderlyName" readonly style="color: #CCCCCC;" autocomplete="off"
                       class="layui-input" th:value="${elderly.name}">
                <input type="hidden" name="elderlyId" autocomplete="off" class="layui-input" th:value="${elderly.id}">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label ">身份证号</label>
            <div class="layui-input-block">
                <input type="text" readonly style="color: #CCCCCC;" autocomplete="off" class="layui-input"
                       th:value="${elderly.idNo}">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label must">楼号</label>
            <div class="layui-input-block">
                <input type="text" name="buildingNo" th:value="${checkInRecords.buildingNo}" readonly
                       lay-verify="required" autocomplete="off" class="layui-input layui-disabled">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label must">房间号</label>
            <div class="layui-input-block">
                <input type="text" name="roomNo" th:value="${checkInRecords.roomNo}" readonly lay-verify="required"
                       autocomplete="off" class="layui-input layui-disabled">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label must">床号</label>
            <div class="layui-input-block">
                <input type="text" name="bedNo" th:value="${checkInRecords.bedNo}" readonly lay-verify="required"
                       autocomplete="off" class="layui-input layui-disabled ">
                <input type="hidden" name="bedId" th:value="${checkInRecords.bedId}">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label must">退院原因</label>
            <div class="layui-input-block">
                <select name="checkOutCause" lay-verify="required">
                    <option value=""></option>
                    <option value="0">自愿</option>
                    <option value="1">死亡</option>
                    <option value="2">其他</option>
                </select>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label must">退院时间</label>
            <div class="layui-input-block">
                <input type="text" readonly autocomplete="off" name="checkOutDate" class="layui-input" id="checkOutDate">
            </div>
        </div>
        <div class="layui-form-item" id="uploadLaborContract">
            <label class="layui-form-label ">上传退院手续</label>
            <div class="layui-input-block">
                <div class="layui-upload layui-inline" id="checkOutMessages">
                    <div class="layui-upload-list">
                        <img class="layui-upload-img" src="/static/imgs/imgup.png" id="checkOutMessage">
                    </div>
                </div>
            </div>
        </div>
        <div class="layui-form-item">
            <div class="layui-input-block">
                <button class="layui-btn  layui-btn-normal" lay-submit lay-filter="submitBtn">确认退院</button>
                <a href="/gbElderly/elist" class="layui-btn layui-btn-primary">返回</a>
            </div>
        </div>
    </form>
</div>


<script th:src="@{/static/plugins/jquery.js}"></script>
<script th:src="@{/static/plugins/layui/layui.js}"></script>
<script th:src="@{/static/js/common.js}"></script>
<script th:src="@{/static/plugins/jquery-migrate-1.2.1.min.js}"></script>
<script th:src="@{/static/js/elder/checkoutrecords/checkOut.js}"></script>


</body>

</html>